The Effect of Non-Surgical Periodontal Treatments on the Severity of Arthritis Rheumatoid

Research Article | DOI: https://doi.org/10.31579/2693-4779/038

The Effect of Non-Surgical Periodontal Treatments on the Severity of Arthritis Rheumatoid

  • Narjes Akbari ID 1
  • Vajehallah Raeesi ID 2
  • Ahmadreza Sebzari ID 3
  • Marziyeh Talaei ID 4
  • Hakimeh MalakiMoghadam ID 5
  • Elham Atabati ID 6*

1 Associate Professor of oral medicine, Faculty of dentistry, Birjand University of medical Sciences, Birjand, Iran.
2 Assistant Professor, Department of internal medicine, Birjand University of medical Sciences, Birjand, Iran
3 Assistant Professor, Clinical Researsh Development unit, Valiasr Hospital, Birjand University of medical Sciences, Birjand, Iran
4 Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
5 MSc in biostatistics, Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
6* Assistant Professor, Clinical Researsh Development unit, Valiasr Hospital, Birjand University of medical Sciences, Birjand, Iran

*Corresponding Author: Elham Atabati, Assistant Professor, Clinical Researsh Development unit, Valiasr Hospital, Birjand University of medical Sciences, Birjand, Iran

Citation: N Akbari, A Sebzari, M Talaei, H M Moghadam, E Atabati et al. (2021) The Effect of non-Surgical Periodontal Treatments on the Severity of Arthritis Rheumatoid. Clinical Research and Clinical Trials. 3(4); DOI:10.31579/2693-4779/038

Copyright: © 2021 Elham Atabati. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 17 April 2021 | Accepted: 28 April 2021 | Published: 18 May 2021

Keywords: arthritis rheumatoid; tooth cleaning; antibiotic

Abstract

Background: periodontal disease with alveoli bone degeneration and losing teeth is seen in many people, including those with arthritis rheumatoid.
Objective This study aims to evaluate the effect of non-surgical periodontal treatments on the severity of arthritis rheumatoid.
Methods: this randomized control clinical trial was conducted on 60 patients who concurrently had arthritis and mild to moderate periodontitis. Patients divided into three groups of 20 subjects (group C had tooth cleaning and antibiotic therapy, group B had only tooth cleaning and group A was control). DAS28 questionnaire was filled out for all three groups at the beginning of the study. After ending the treatment and improvement, patients were examined in days 45 and 90 in terms of improvement indicators for arthritis rheumatoid. Data were finally analyzed by SPSS18.
Results: the highest reduction rate of ESR, DAS28, CRP and RF was in different time periods in tooth cleaning intervention +antibiotic group and then, teeth cleaning group. The lowest reduction was seen in control group. RF, CRP and DAS28 indices showed significant differences in different time periods in tooth cleaning group and tooth cleaning+ antibiotic group (P<0.05).
Conclusion: non-surgery periodontal treatment and RA indices, without considering the medicines used for treatment, had positive effect on the treatment of this disease.

Introduction

World Health Organization (WHO) considers oral hygiene as a necessity and a part of public health in lifetime and states that the health impacts the quality of life. Besides, some chronic diseases are related with oral and dental problems; therefore, paying attention to this issue is one of the programs of WHO in preventing chronic disease and promoting health [1].

More than several thousand people suffer periodontal diseases around the world. The prevalence of these diseases are high, even higher than tooth caries [2]. There are various types of periodontal diseases that their common feature is changing the ideal condition of periodontium and providing a ground for destruction [3]. Periodontal disease are the major cause of losing permanent teeth. Inflammation, bleeding, gingivitis, bone degradation, tooth displacement, pain and other problems are other side-effects of periodontal diseases [4].

Various studies have shown that demographic factors such as age and gender, socio-economic conditions, inflammatory factors, systemic conditions, drugs and other factors lead to periodontal disease [5].

The research showed that from among 10 people, 9 people suffer periodontal disease during their lifetime [6]. Based on the research about periodontitis and systemic diseases, there is a relationship between periodontal diseases and arthritis rheumatoid, cardiovascular disease and mellitus diabetes. Similar cases have been reported in pathobiology of periodontitis and arthritis rheumatoid [7, 8].

Arthritis rheumatoid is a mild and chronic autoimmune disease but it can be severe and paralyzing. This disease occurs around the world and approximately 1% of the world population suffer it. The prevalence of this disease in women is 3 times of men. This disease occur in decades four and five of life. 3% of US population suffer this disease to some degree and more than 200,000 new cases are diagnosed every year [9].

The definite and common role of the immune response is clear in this disease and periodontitis. Although the etiology of these two diseases are different, the basic pathogens mechanism is similar in all of them. On the other hand, there is a significant relationship between these two diseases which is a reflection of a basic disorder in inflammatory reaction of these people. There are evidence that show arthritis rheumatoid is one of the causes of periodontitis [10]. Patients susceptible to arthritis rheumatoid may suffer periodontitis in the presence of periodontal pathogens and suitable environment. Soory studied the definite role of immune reaction in diabetes, arthritis rheumatoid and periodontal disease and confirmed the relationship between these diseases and periodontal diseases. Since there is a similarity between periodontitis pathobiology and arthritis rheumatoid and the role of immune reaction is proved in these diseases [11], as well as consulting and referring these patients by physicians to dentists and high prevalence of them, it is vital to study and prevent the problems related to these diseases. Therefore, this research aims to study the role of periodontal diseases on the severity of arthritis rheumatoid in order to increase the awareness about prevention and provide services.    

Materials and Methods

This is a randomized clinical trial with control.
The samples were selected voluntarily and randomly from among those patients who visited Valiasr educational hospital in Birjand.
After data collection, data were entered in SPSS software version 18 and by providing descriptive statistics and using repeated variance tests, Bonferoni test, chi-square test, and ANOVA, they were analyzed in a=0.05 level. In the case of lack of data normality distribution, Wilcoxon, Freidman, Kruskal-Wallis and Mann-Whitney non-parametric tests were used.
The private information of the studied people remained confidential.
Since tooth cleaning is not considered in the care protocol of arthritis rheumatoid patients, delaying it in the control group was permissible. Periodontal treatment was done for control group at the end of work.

Results

This study was conducted on 60 patients in three groups of 20 subjects including control, tooth-cleaning, and tooth cleaning+ antibiotic groups. From among 60 patients in this study, except one men in tooth-cleaning group, all other subjects were women and both groups were same in terms of gender (Fisher exact test=1). Mean age in both groups had not significant statistical difference.
Based on the above table data, there was no significant different in mean age of three studied groups and three groups were same in terms of age.
Based on the following table data, mean DAS showed significant difference after intervention in all three groups. This reduction had significant difference among the three groups in the studied periods (P<0.05) (table 1).

Table 1: comparing mean of DAS in three studied groups, before, 45 days and 90 days after intervention

Based on following table data, mean ESR showed significant reduction after intervention in three groups. This difference was significant in different time period in all three groups. There was no significant difference before intervention and 45 days after intervention in mean ESR of three groups but ESR was significantly lower in tooth cleaning and tooth cleaning+ antibiotics groups than control group (P<0.001) (table 2).

Table 2: comparing mean ESR in three studied groups before, 45 days and 90 days after intervention

Mean CRP showed no significant difference at three studied time periods but there was significant reduction in tooth cleaning and tooth cleaning+ antibiotics groups after intervention in CRP mean. This difference showed significant statistical difference at all time periods (P<0.05) (table 2).  

Based on the following table, RF index in control group did not show significant statistical difference in three study time periods but in the tooth cleaning and tooth cleaning+ antibiotics groups, mean RF showed significant reduction after intervention and this reduction was also significant in different time periods. Before intervention, RF index was same in all three groups but 45 and 90 days after intervention, RF was significantly higher in control group than two other groups (P<0.01) (table 2).

Mean DAS changes in all study time periods showed higher reduction in tooth cleaning + antibiotic group than tooth cleaning group and also in tooth cleaning group than control group. This difference between mean of DAS of groups was statistically significant (P<0.01)

Although the highest ESR reduction was in tooth cleaning + antibiotic and then, tooth cleaning groups and the lowest ESR reduction was in control group, but these differences were not statistically significant (P>0.05) Although the highest CRP reduction was in tooth cleaning + antibiotic and then, tooth cleaning groups and the lowest CRP reduction was in control group. This was statistically significant (P>0.05) although the highest RF reduction was in tooth cleaning + antibiotic and then, tooth cleaning groups and the lowest RF reduction was in control group. This was statistically significant in intervention and control groups (P>0.05)

Discussion

Arthritis rheumatoid is the most common chronic and inflammatory disease of joint that can lead to the degeneration of joints, disability and motor limitation of patients. About 30% of those who suffer arthritis rheumatoid may suffer secondary Sjögren syndrome that is an autoimmune exocrinopathy. In this condition, due to the reduction of salvia and fry mouth and as a result, reducing the antibacterial effects of salvia, periodontal disease intensifies [29]. Periodontitis is the most common oral disease; it is an inflammatory and degenerating disease of tooth tissues that occurs by microorganisms like Porphyromonas gingivalis. In a person who have immune suppression, poor defense and safety caused by chronic disease like arthritis rheumatoid, gum inflammation is more common and sever [30]. Therefore, this study was conducted to examine the effect of non-surgical periodontal treatments on the severity of arthritis rheumatoid.

According to this study, all 90 patients were women expect one. In different studies, the prevalence of this disease is higher in women than men [31, 32]. Lipsky PE has reported in Harrison book that arthritis rheumatoid is three times higher in women than men [33].

Based on the results of this study, in all three groups, mean DAS showed significant reduction after intervention. This reduction indicated significant statistical difference in all three groups in the study time periods (P<0.05) but mean changes of DAS reduced more in tooth cleaning+ antibiotic than tooth cleaning and also in tooth cleaning than control group.

These findings were consistent with previous findings [34, 35] that indicate the positive effect of periodontal treatment on RA condition. Oritz et.al [38] studied the effect of periodontal disease treatment on the severity of arthritis rheumatoid and reported that periodontal treatment reduces DAS28 in these patients, such that DAS28 showed more reduction in tooth cleaning method than control group and this reduction was statistically significant. Their results were consistent with the present study.

Ebersole JL et.al stated that periodontal disease is a systemic inflammatory disease and periodontal treatment only reduces inflammatory products. Therefore, periodontal treatment leads to the reduction of inflammatory markers in arthritis rheumatoid patients. Another explanation is that eliminating periodontal pathogens using tooth cleaning and extending the root reduces the encounter between bacteria and their toxin with joints structure, and consequently, it improves RA conditions [37]. Most exclusive traits of microorganism to become a suitable genetic host for arthritis rheumatoid are present in those microorganisms that are related to periodontitis [11].

 The results of this study showed that there was no significant difference in mean ESR before intervention and 45 days after intervention among three groups but in 90 days after intervention, ESR was significantly lower in tooth cleaning group and tooth cleaning+ antibiotic group than control group (P<0.001). The highest ESR reduction was in tooth cleaning + antibiotics group and then, tooth cleaning group. The lowest reduction was of ESR was in control group.

In Al-Katma et.al study, ESR improved %76.4 in group with training and tooth cleaning but it improved %16.7 in control group. There was a significant difference between both groups in terms of ESR that after 8 weeks, it showed the effect of tooth cleaning on improving EST. This is consistent with our study [35].

In Juliana Riberio et.al study (2005) about the effect of periodontal disease on the severity of arthritis rheumatoid, periodontal treatment was an effective factor in reducing the severity of arthritis rheumatoid such that most people with tooth cleaning showed lower ESR than control group. This difference in mean ESR was significant in both groups [34].

Amoxicillin and metronidazole were used in periodontal treatment. The used dose of antibiotics was similar to other studies [38-40]. These studies showed the useful effect of systematic prescribing of antibiotics as supplement and reported no serious side-effect except mild intestinal problems.

Some clinical studies showed that non-surgical treatment along with using systemic antibiotic is useful [41]. In the present study, using antibiotics along with tooth cleaning had the higher effect on improving the periodontal condition as well as arthritis rheumatoid.

 The results of the current study showed that there is no significant difference in CRP in three studies time periods in the control group but there was a significant reduction in mean CRP after intervention in tooth cleaning group and tooth-cleaning+ antibiotics group. This difference was statistically different (P<0.05). The highest CRP reduction in different time period in was tooth cleaning + antibiotics followed by tooth cleaning group. The lowest reduction of CRP was in control group and this difference was statistically different (P<0.05).

In Heidari et.al study [42] about the relationship between serum CRP concentration with arthritis rheumatoid, it was stated that there is a direct relationship between CRP concentration in serum and arthritis rheumatoid and the severity of disease can be estimated in some patients based on serum CRP.

Marcia et.al [43] studied the relationship between periodontal disease with arthritis rheumatoid and effect of periodontal treatments on arthritis. They reported that groups with periodontal treatment showed strong reduction in all parameters (periodontal indices and RA). They stated that although the correlation between periodontal disease and arthritis rheumatoid is not clear yet but periodontal treatment is necessary for patients with RA.

Al-Katma [35] stated that periodontal inflammation produces globulins, plasma proteins (like hepatoglobulis), C-reactive protein and fibrinogen. The improvement of symptoms and indices related to RA (CRP, DAS28, ESR) in periodontal treatment group compared to control group may be due to the reduction of inflammatory products in the blood after periodontal treatment. In D'Aiuto et.al study [44], two months after SRP and plaque control, the significant reduction in CRP and interlukin-6 was seen in periodontal treatment group that is consistent with our results.

The findings of other studies [22, 45] also indicated the effect of periodontal treatment on reducing CRP that are consistent with the current study results. 

Based on the results of its study, there was no significant difference in mean RF in control group in three time period but RF showed significant reduction in tooth cleaning group and tooth cleaning+ antibiotic group after intervention. RF was same in all three groups before intervention but it was significantly higher in control group 45 days and 90 days after intervention (P<0.01).

In Juliana Riberio et.al study [34], RF reduced in group with periodontal treatment compared to control group but this difference was not statistically different. This is not consistent with the results of our study.

The results of Khare N1 et.al study (2016) are consistent with our results such that group B who received periodontal non-surgical treatments, improved significantly in terms of periodontitis and RA factors. The symptoms and severity of RA also decreased [21].

One advantage of this study was comparing tooth cleaning with tooth cleaning along with antibiotic therapy in arthritis rheumatoid patients. Similar studies [35, 36] have only dealt with the effect of tooth cleaning.

Conclusion

  1. The highest reduction of ESR, DAS28, CRP and RF in different time periods was in tooth cleaning+ antibiotic group followed by tooth cleaning group. The lowest reduction was in control group.
  2. Based on the results of this study, RF and CRP showed no significant statistical difference in three time periods in control group but it showed significant reduction in tooth cleaning, and tooth cleaning + antibiotics groups after intervention in different time periods (P<0.05).
  3. Mean DAS28 showed significant difference after intervention in all three studied groups. This reduction showed statistical significant difference in three groups at different time periods.
  4. Before intervention and 45 days after intervention, there was no significant difference in mean ESR of all three groups but 90 days after intervention. ESR was significantly lower in tooth cleaning and tooth cleaning+ antibiotics group than control group (P<0.001).

Funding

This work received support from Birjand University of medical Sciences, Birjanad, Iran.

Financial Support

This paper is extracted from thesis of Ms. Marzieh Talaee, dentistry student of Birjand University of medical sciences under ir.bums.REC.1396.353 number.

Disclosure statement

The authors have declared no conflicts of interest

Authors Contribution

Elham Atabati and Narjes Akbari conceived of the presented idea. Marziyeh Talaei developed the theory and performed the computations. Vajehallah Raeesi and Ahmadreza Sebzari verified the analytical methods.  Hakimeh MalakiMoghadam analyzed data. Elham Atabati encouraged Marziyeh Talaei to investigate and supervised the findings of this work. All authors discussed the results and contributed to the final manuscript.

Acknowledgement

The authors would like to appreciate the research deputy of dentistry faculty, Birjand medical sciences university that provided required facilities for this research.

References

Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.

img

Virginia E. Koenig

Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.

img

Delcio G Silva Junior

Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.

img

Ziemlé Clément Méda

Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.

img

Mina Sherif Soliman Georgy

We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.

img

Layla Shojaie

The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.

img

Sing-yung Wu

Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.

img

Orlando Villarreal

Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.

img

Katarzyna Byczkowska

Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.

img

Anthony Kodzo-Grey Venyo

Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.

img

Pedro Marques Gomes

Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.

img

Bernard Terkimbi Utoo

This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.

img

Prof Sherif W Mansour

Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.

img

Hao Jiang

As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.

img

Dr Shiming Tang

Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.

img

Raed Mualem

International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.

img

Andreas Filippaios

Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.

img

Dr Suramya Dhamija

Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.

img

Bruno Chauffert

I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!

img

Baheci Selen

"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".

img

Jesus Simal-Gandara

I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.

img

Douglas Miyazaki

We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.

img

Dr Griffith

I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.

img

Dr Tong Ming Liu

I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.

img

Husain Taha Radhi

I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.

img

S Munshi

Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.

img

Tania Munoz

“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.

img

George Varvatsoulias

Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.

img

Rui Tao

Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.

img

Khurram Arshad